Relationships of choice: can friendships or fictive kinships explain the race paradox in mental health?

Psychological Distress in Adults With Myocardial Infarction: Implications for Health Care Utilization and Expenditure

Background

Myocardial infarction (MI) poses a major financial burden on the U.S. health care system, but its impact on medical expenses and health care utilization when coupled with psychological distress remains unknown.

Objectives

The study aims to investigate the association between psychological distress and healthcare utilization and medical expenditures in adults with a history of MI.

Methods

We analyzed the 2017-2021 Medical Expenditure Panel Survey to identify 44,716 adults with a history of MI. Psychological distress was measured using the Kessler (K6) questionnaire, with a score of ≥13 indicating clinically significant distress. Differences in medical expenditures and health care utilization between patients with MI with and without psychological distress were assessed using weighted generalized linear and negative binomial regression models. Expenditures, medical visits, and prescribed medications are reported as means and 95% CI.

Results

Among 9,773,458 weighted adults, 970,049 experienced psychological distress. Adults with MI and psychological distress were younger, more likely to be female (51.1% vs 37.5%; P < 0.001), less educated (11.1 vs 12.5 years; P < 0.001), lower income, and were more likely to have public insurance, compared to those without psychological distress. Adults with psychological distress and a history of MI had higher average medical expenses ($31,577 vs $15,830; P < 0.001) and greater health care utilization including office visits (8.3 vs 5.7; P = 0.01), inpatient visits (0.6 vs 0.3; P < 0.001), emergency room visits (0.7 vs 0.3; P < 0.001), and prescribed medications including refills (42.3 vs 28; P < 0.001).

Conclusions

Psychological distress is correlated with increased medical expenditures and health care utilization in patients with MI. This research highlights the need for interventions addressing psychological needs in patients with MI.

A paradox of white privilege: race, psychological resilience, and mental well-being during a public health crisis

OBJECTIVES

The present study sheds novel light on the so-called 'racial paradox in mental health,' i.e., the phenomenon that Blacks, despite their relative socioeconomic disadvantages are mentally healthier than their more privileged White counterparts in the US. Evidence from prior research has been largely based on non-probability or regional surveys fielded during 'ordinary' times. In contrast, we analyze probability data on American adults collected during the extraordinary period of the COVID-19 pandemic across the country.

DESIGN

Data came from the Census Household Pulse Survey (CHPS). The CHPS sampled community-dwelling U.S. adults across 50 States and the District of Columbia using the Master Address File (MAF). Data collection began on April 23 2020 and was carried out on a biweekly basis. We used three phases of data covering 21 weeks in total (with the week ending on February 1, 2021). Mixed-effects (multilevel) modeling was employed to analyze the data.

RESULTS

Statistical results show that compared to their Black counterparts Whites fared worse mentally during the pandemic. We also found that the magnitude of the focal association is stronger with greater vulnerability operationalized at the individual level, i.e., in the context of lower income, job insecurity, and food shortage. Additionally, significant cross-level interactions emerged: the effect of race was more pronounced in geographic regions with higher coronavirus infection, greater ethnic heterogeneity, and higher structural disadvantage.

CONCLUSION

Our research supports existing studies that Blacks vis-à-vis Whites are psychologically more resilient. We add to the literature by shedding novel light on the mental health paradox during the extraordinary times brought about by the COVID-19-induced public health crisis. Ironically, there is a mental cost involved with the 'White privilege' in the US.

Race/Ethnicity, Nativity, and Gender Disparities in Mental Health Trajectories from Mid- to Later-Life: A Life Course-Intersectional Approach

BACKGROUND

Numerous studies have highlighted mental health disparities based on race/ethnicity, nativity, and gender across different life stages. However, few have investigated how the intersectionality of these factors influences mental health trajectories during midlife to late life. This study fills this gap by adopting a life course-intersectional approach, viewing mental health trajectories as dynamic processes shaped by the combined influences of race/ethnicity, nativity, and gender. It explores social, psychological, and physiological pathways contributing to these disparities.

DESIGN

Using data from the Health and Retirement Study (2006-2018; N = 38,049 observations) and growth curve models, this study examines how intra-individual trends in depressive symptoms (measured as CES-D scale, 07) are influenced by the intersection of race/ethnicity, nativity, and gender. It also investigates the impact of objective and subjective social isolation and physical health on group disparities in mental health trajectories.

RESULTS

The findings reveal that, during mid- to early late-life, most Black and Hispanic Americans experience higher levels of depressive symptoms compared to their White counterparts (disparities ranging from 0.184 to 0.463 for men and 0.117 to 0.439 for women). However, this disadvantage diminishes for US-born Hispanic men and US-born Black women (0.014-0.031 faster decrease rates compared to US-born White), while it intensifies for Hispanic immigrants (0.017-0.018 slower decrease rates compared to US-born White) in advanced ages. Mediation analysis demonstrates that both social isolation and physical health contribute to these disparities, with physical health explaining a larger portion, particularly in differences between immigrant Hispanic women and US-born Whites.

CONCLUSION

This study underscores the importance of a life course-intersectional approach in understanding mental health disparities. It emphasizes the need for improved social welfare systems and community-level interventions targeting the specific challenges faced by older Hispanic immigrants, especially women who encounter multiple forms of oppression.

Central Hemodynamics in African American Women: Examining the Role of Superwoman Schema Endorsement

BACKGROUND

African American women bear a disproportionate burden of cardiovascular diseases, potentially due to altered central hemodynamics. Racism and sexism often lead to African American women taking on numerous caretaking roles and overall increases their use of the Strong Black Woman (ie, Superwoman) mindset, which may have negative health consequences. We hypothesized that endorsing the Superwoman role and its Obligation to Help Others dimension would be associated with a deleterious central hemodynamics profile in African American women.

METHODS AND RESULTS

Using cross-sectional data, we examined central systolic blood pressure (mm Hg; n=408), augmentation index (percentage, adjusted for height and heart rate; n=408), and pulse wave velocity (m/s; n=368) in African American women aged 30 to 46 years. The Giscombe Superwoman Schema (SWS) questionnaire assessed endorsement of Overall SWS (range, 0-105) and SWS-Obligation to Help Others (range, 0-3). Multiple linear regression modeled associations between Overall SWS (10-unit increments) and SWS-Obligation to Help Others (1-unit increments) and central hemodynamics while adjusting for pertinent sociodemographic, clinical, and psychosocial factors. In fully adjusted models, central systolic blood pressure was significantly associated with Overall SWS (β=0.83 [95% CI, 0.19-1.47]) and SWS-Obligation to Help Others (β=2.03 [95% CI, 0.39-3.67]). Augmentation index was associated with Overall SWS (β=0.66 [95% CI, 0.02-1.30]) and SWS-Obligation to Help Others (β=2.21 [95% CI, 0.58-3.84]). Significant associations were not observed between pulse wave velocity and SWS.

CONCLUSIONS

Greater endorsement of the Superwoman role and prioritizing caregiving over self-care were associated with higher central systolic blood pressure and augmentation index, which may contribute to adverse cardiovascular health among African American women.

Racial Differences in Biopsychosocial Pathways to Tobacco and Marijuana Use Among Youth

BACKGROUND

The influence of socioeconomic disparities and multidimensional stressors on youth tobacco and marijuana use is recognized; however, the extent of these effects varies among different racial groups. Understanding the racial differences in the factors influencing substance use is crucial for developing tailored interventions aimed at reducing disparities in tobacco and marijuana use among adolescents.

AIMS

This study aims to explore the differential effects of socioeconomic disparities and multidimensional stressors on tobacco and marijuana use between Black and White adolescents.

METHODS

Utilizing longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, this research includes a cohort of pre-youth, monitored from the age of 9-10 years for a period of up to 36 months. We examined the impact of various socioeconomic status (SES) indicators and multidimensional stressors, including trauma, financial stress, racial discrimination, and family stress, alongside baseline average cortical thickness and the subsequent initiation of tobacco and marijuana use over the 36-month follow-up.

RESULTS

Overall, 10,777 participants entered our analysis. This included 8263 White and 2514 Black youth. Our findings indicate significant differences in the pathways from SES indicators through stress types to cortical thickness between Black and White youths. Notably, cortical thickness's impact on the future initiation of tobacco and marijuana use was present in both groups.

CONCLUSION

The study suggests that compared to White adolescents, Black adolescents' substance use and associated cortical thickness are less influenced by stress and SES indicators. This discrepancy may be attributed to the compounded effects of racism, where psychosocial mechanisms might be more diminished for Black youth than White youth. These findings support the theory of Minorities' Diminished Returns rather than the cumulative disadvantage or double jeopardy hypothesis, highlighting the need for interventions that address the unique challenges faced by Black adolescents.

Disparities in COVID-19-Related Psychological Distress Among Recipients of a State's Public Mental Health Services

OBJECTIVE

The authors examined changes in perceived anxiety, stress, and mental health symptoms (i.e., psychological distress) reported by recipients of New York State public mental health services during the early months of the COVID-19 pandemic, as well as whether these changes varied by demographic characteristics or pandemic-related socioeconomic challenges.

METHODS

A statewide survey of service recipients (N=3,483) was conducted (May 8-June 22, 2020). Descriptive analyses were summarized, and logistic regression was used to evaluate associations between increases in reported psychological distress and age, gender, region of residence, race and ethnicity, socioeconomic challenges, and alcohol or drug use.

RESULTS

Fifty-five percent of respondents (N=1,933) reported a slight or moderate increase in COVID-19-related psychological distress, and 15% (N=520) reported a substantial increase. In adjusted models, substantial elevations in psychological distress were associated with identifying as female (AOR=1.83, 95% CI=1.50-2.25), experiencing three or more pandemic-related socioeconomic challenges (AOR=2.41, 95% CI=1.91-3.03), and reporting increased use of alcohol or drugs (AOR=1.81, 95% CI=1.34-2.44). Compared with non-Hispanic/Latinx White service recipients, non-Hispanic/Latinx Black individuals had lower odds of reporting substantially increased psychological distress (AOR=0.59, 95% CI=0.45-0.76), as did non-Hispanic/Latinx Asian-descent individuals (AOR=0.28, 95% CI=0.12-0.64).

CONCLUSIONS

In this large sample of recipients of New York State public mental health services, the COVID-19 pandemic's impact on psychological well-being was widespread and varied by gender, race and ethnicity, and socioeconomic vulnerability. These relationships must be considered in ongoing efforts to provide optimal care for this population.

Do Police Encounters Increase the Risk for Cardiovascular Disease? Police Encounters and Framingham 30-Year Cardiovascular Risk Score

INTRODUCTION

Despite increased attention to the societal consequences of aggressive policing, the focus on rarer instances of deaths/severe injuries fails to fully capture the day-to-day experiences that racially minoritized groups face during police encounters (PEs). We explored differential vulnerability by race/ethnicity in the relationship between PEs and cardiovascular disease (CVD) risk.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, we regressed the Framingham 30-Year CVD risk score on a high number of lifetime PEs (6 + among men and 2 + among women). To explore differential vulnerability by race, we added an interaction between PEs and race/ethnicity. We also examined sex- and race and sex-stratified models.

RESULTS

We observed no association between PEs and CVD risk in the sample overall, but the interaction between PEs and race/ethnicity was statistically significant. In race stratified models, we found that higher PEs were associated with a lower CVD risk among Black respondents, whereas among White respondents there was no relationship. In the sex-stratified analysis, reporting higher PEs was associated with lower CVD risk among men, while among women there was no relationship. In sex- and race-stratified models, higher PEs was associated with lower CVD risk among Black men and higher CVD risk among White women, while there was no association among Black women and White men.

CONCLUSION

The association between PEs and CVD risk depends on race/ethnicity and sex. More work is needed to understand the counterintuitive finding that high PEs are associated with lower CVD risk among Black men.

Revisiting the Black-White Mental Health Paradox During the Coronavirus Pandemic

Black Americans have lower rates of depression and anxiety than Whites, despite greater exposure to stressors known to negatively impact mental health, characterized as the Black-White mental health paradox. This study revisited the paradox during the coronavirus pandemic. Drawing on stress process theory, minority stress theory, and the rejection-identification model of discrimination, in-group identity, and well-being, we analyzed original survey data from a quota sample of African American and White adults (N = 594). The survey included a range of stressors and coping resources, including those relevant to the pandemic (e.g., COVID-19 illness) and race (e.g., witnessing anti-Black police violence). Results indicate that despite African Americans' greater exposure and vulnerability to racial discrimination, the Black-White mental health paradox holds, owing in part to protective effects of African American's higher self-esteem. Directions for future exploration of the paradox are presented based on this study's findings.

Investigating a Paradox: Toward a Better Understanding of the Relationships Between Racial Group Membership, Stress, and Major Depressive Disorder

Epidemiologic studies in the United States routinely report a lower or equal prevalence of major depressive disorder (MDD) for Black people relative to White people. Within racial groups, individuals with greater life stressor exposure experience greater prevalence of MDD; however, between racial groups this pattern does not hold. Informed by theoretical and empirical literature seeking to explain this "Black-White depression paradox," we outline 2 proposed models for the relationships between racial group membership, life stressor exposure, and MDD: an effect modification model and an inconsistent mediator model. Either model could explain the paradoxical within- and between-racial group patterns of life stressor exposure and MDD. We empirically estimated associations under each of the proposed models using data from 26,960 self-identified Black and White participants in the National Epidemiologic Survey on Alcohol and Related Conditions III (United States, 2012-2013). Under the effect modification model, we estimated relative risk effect modification using parametric regression with a cross-product term, and under the inconsistent mediation model, we estimated interventional direct and indirect effects using targeted minimum loss-based estimation. We found evidence of inconsistent mediation (i.e., direct and indirect effects operating in opposite directions), suggesting a need for greater consideration of explanations for racial patterns in MDD that operate independent of life stressor exposure. This article is part of a Special Collection on Mental Health.

A Meta-Regression of Racial Disparities in Wellbeing Outcomes During and After Foster Care

Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster care as an intervention are heterogeneous. Heterogeneity outcomes by race and ethnicity are of particular interest, given that Black and Indigenous youth experience foster care at higher rates than other racial/ethnic groups and experience group differences in setting, duration, and exits to permanency. This meta-regression explores racial disparities in education, employment, mental health, and behavioral outcomes during and following foster care. A systematic search of PsycINFO, ERIC, and Academic Search Complete using a series of search terms for studies published between January 2000 and June 2021 found 70 articles and 392 effect sizes that provided outcomes of US-based foster care by race/ethnicity. Findings reveal that Black foster care impacted persons (FCIPs) have 20% lower odds (95% CI: .68-.93) of achieving employment or substantial financial earnings and have 18% lower odds (95% CI: .68-1.00) of mental health concerns compared to White FCIPs. Hispanic FCIPs have 10% lower odds (95% CI: .84-.97) of achieving stable housing compared to non-Hispanic FCIPs. Moderator analyses revealed certain study features (i.e. publication type, timing of the study, location of the study, and placement status of the participants) have a significant impact on the gap between Black and non-Black and Hispanic and non-Hispanic FCIPs. The findings provide important implications for racial disparities in foster care outcomes, as well as highlight important gaps and missing information from published studies.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

Friendships and Emotional Well-Being in the Context of Race and Age

BACKGROUND AND OBJECTIVES

Research suggests that friendships are associated with better emotional outcomes. Still, little is known about the implications of daily friend encounters on emotional well-being in the context of race and age. Guided by the integrative conceptual framework for friendship research, this study considers racism and cultural beliefs associated with racial groups and different social and emotional goals associated with age and investigates whether the frequency of friend encounters and the link between friend encounters and emotional well-being in everyday life would vary by race and age.

RESEARCH DESIGN AND METHODS

Black (n = 80; Mage = 53.62) and White American adults (n = 89, Mage = 52.01) from the Stress and Well-being in Everyday Life study provided background and social network information, followed by ecological momentary assessment surveys in which they reported their social encounters and mood every 3 hours for 4 consecutive days.

RESULTS

Multilevel linear models revealed no significant differences by race or age in the frequency of friend encounters. At times when individuals were with friends, their positive mood was elevated compared to when they were not (within-person association). Yet, this association was observed only among White adults and among Black individuals who were aged 41 or younger.

DISCUSSION AND IMPLICATIONS

This work contributes to the conceptual framework for friendship research by considering how individuals' race and age are linked to friendship patterns. Findings highlight the importance of everyday contact with friends for enhancing momentary emotional well-being, particularly among White individuals and younger Black adults.

Depression impairment among young adult college students: exploring the racial paradox

BACKGROUND

Studies suggest Black Americans have a lower prevalence of depression than White Americans despite greater exposure to risk factors for depression across the life course. We examined whether this paradox exists among students in higher education, and whether the paradox may be partly explained by racial differences in reports of impairment from depression, which is a required criterion for clinical diagnosis.

METHODS

We analyzed data from the Healthy Minds Study (2020-2021), restricting the sample to young adults (18-29) who identified as either Black or White. Using modified Poisson regression models to estimate risk ratios, we examined associations between race and depression impairment across five levels of depression severity, adjusting for age and gender.

RESULTS

Approximately 23% of Black students reported depression impairment, which is significantly lower than the 28% of White students who reported depression impairment. For all students, greater depression severity was associated with greater probability of impairment; however, the relationship was more modest among Black students. At severe, moderately severe, and moderate depression levels, Black students had lower risk of depression impairment compared with White students.

CONCLUSION

White students may be more likely than Black students to report significant impairment at high levels of depression. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some the racial depression paradox.

Number of Chronic Medical Conditions and Quality of Life of Ethnic Minority Older Adults

Background: The Blacks’ mental health paradox is defined as disproportionately better mental health among Black individuals compared to White individuals, despite their higher exposure to a wide range of adversities. However, the existing literature on this phenomenon is mainly limited to studies that have compared Black and White individuals. There has been little research on this phenomenon among ethnic groups other than Whites. Objectives: This study tested the Blacks’ mental health paradox with consideration of Latinx individuals as the control group. Methods: This cross-sectional study collected demographic data, socioeconomic status, chronic medical conditions, and mental and physical quality of life of 724 older Black and Latinx adults residing in low socioeconomic areas of south Los Angeles. Linear regressions were used for data analysis with mental and physical health-related quality of life (HRQoL) as dependent variables and the number of chronic medical conditions as the independent variable. Results: Overall, a higher number of chronic medical conditions was associated with lower mental and physical quality of life. A statistically significant interaction was found between race/ethnicity and the effect of the number of chronic medical conditions on mental HRQoL, which was indicative of Blacks’ mental health paradox. Conclusion: Older Black adults with a higher number of chronic medical conditions report better mental health compared to their Latinx peers with the same number of chronic medical conditions. Thus, Blacks’ mental health paradox can be seen when Black and Latinx populations are compared. Replication of such a paradox provides additional support for the relative mental health advantage of Black people compared to other ethnic groups.

Neighborhood cohesion and psychological distress across race and sexual orientation

Introduction

Method

Result

Conclusion

•

Lesbian, gay, and bisexual (LGB) people are more likely to meet the criteria for psychological distress than non-LGB people.

•

Neighborhood cohesion (NC) has differing impact on psychological distress by race and sexual orientation.

•

NC provides greater protection against moderate distress for non-LGB groups and severe psychological distress for LGB groups.

COVID-19 and Psychological Distress: Racial Differences Among Middle-Aged and Older Adults

BACKGROUND AND OBJECTIVES

COVID-19 has disproportionately impacted older adults and Black individuals. Research has focused on physical outcomes, with less attention to the psychological effects of COVID-19. The objective of this study was to examine the interplay between perceptions of the COVID-19 outbreak as a threat to one's day-to-day life, race, and psychological distress among middle-aged and older men and women.

RESEARCH DESIGN AND METHODS

Analyses were conducted on a subsample of self-identified non-Latino Whites and Black individuals aged 50 and older (N = 3,834) from the American Trends Panel. Psychological distress was assessed with 5 items adapted from the Center for Epidemiologic Studies Depression Scale and Generalized Anxiety Disorder-7. Perceived COVID-19 day-to-day threat was assessed with a single question. Negative binomial regressions tested the study aim.

RESULTS

Perceptions of COVID-19 day-to-day threat were positively associated with psychological distress. Black individuals reported lower distress than Whites. Regardless of gender, greater perceptions of COVID-19 day-to-day threats were associated with greater distress among both White respondents and Black respondents. However, this association was weaker among Black respondents than White respondents. Among men only, the association between COVID-19 day-to-day threat and distress varied by race, patterned similarly to the race differences identified in the total sample. This association did not vary by race among women.

DISCUSSION AND IMPLICATIONS

This study contributes to the emerging literature focused on older adults and COVID-19 related stressors and psychological distress. An intersectional lens shows how structural oppression may shape perceptions of the pandemic. Future work should consider coexisting intersections in marginalized identities and mental health during COVID-19.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men's AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the "quality" rather than the "quantity" of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

Perceived discrimination and mental health among African American and Caribbean Black adolescents: ethnic differences in processes and effects

Objectives: Although the relationship between perceived discrimination and mental health among Black youth is well-documented, the mechanisms underlying this association remain unclear. Drawing from the stress process model, this study examines two psychosocial mediators - self-esteem and self-efficacy - in the association between perceived discrimination and mental health among African American and Caribbean Black adolescents. This research addresses three primary research questions: First, how is perceived discrimination associated with mental health? Second, to what extent do self-esteem and self-efficacy mediate the relationship between perceived discrimination and mental health? Finally, do these relationships and processes differ between African American and Caribbean Black adolescents?Design: Data for these analyses come from the National Survey of American Life - Adolescent Supplement. We use generalized structural equation modeling to examine relationships among perceived discrimination, psychosocial resources, and mental health.Results: For both African American and Caribbean Black adolescents, more frequent perceptions of discriminatory events were associated with greater depressive symptoms and a higher likelihood of having an anxiety disorder diagnosis. However, the association between perceived discrimination and depressive symptoms was significantly stronger for Caribbean Black adolescents. Generally, self-esteem and self-efficacy were found to be significant mediators in the association between perceived discrimination and mental health, although mechanisms varied between African American and Caribbean Black youth.Conclusion: African American and Caribbean Black adolescents are highly susceptible to experiences of discrimination that negatively affect their mental health. Heterogeneity among Black youth populations must be considered when developing interventions to reduce exposure to and the effects of discrimination among these adolescents.

Do Racial Differences in Coping Resources Explain the Black-White Paradox in Mental Health? A Test of Multiple Mechanisms

A central paradox in the mental health literature is the tendency for black Americans to report similar or better mental health than white Americans despite experiencing greater stress exposure. However, black Americans' higher levels of certain coping resources may explain this finding. Using data from the Nashville Stress and Health Study (n = 1,186), we examine whether black Americans have higher levels of self-esteem, social support, religious attendance, and divine control than white Americans and whether these resources, in turn, explain the black-white paradox in mental health. In adjusted models, the black-white paradox holds for depressive symptoms and any DSM-IV disorder. Findings indicate that black Americans have higher levels of self-esteem, family social support, and religiosity than white Americans. Causal mediation techniques reveal that self-esteem has the largest effect in explaining black-white differences in depressive symptoms, whereas divine control has the largest effect in explaining differences in disorder.

Family resilience and childhood obesity among children exposed to adverse childhood experiences in a national survey

OBJECTIVE

Adverse childhood experiences (ACEs) contribute to poor overall health among children with obesity. This study evaluated how one potential protective factor-family resilience-affects the association between ACEs and childhood obesity.

METHODS

This analysis was a secondary analysis of the 2016-2018 National Survey of Children's Health (NSCH), a repeated cross-sectional survey based on parent report. Nine ACEs were queried. Family resilience was assessed with four items (potential range 0-12). The primary outcome was child weight status. Multivariable ordinal logistic regression was used, adjusting for potential confounders and the interaction between ACEs and family resilience.

RESULTS

For 49,365 children ages 10-17, the median number of ACEs was 1 (IQR 0, 2), the median family resilience score was 10 (IQR 8,12), 15.3% of children had overweight, and 15.4% of children had obesity. Among the 51.3% of children who experienced one or more ACEs, higher family resilience scores attenuated the odds of being in a higher weight category. This pattern was not observed in children with zero ACEs.

CONCLUSIONS

In the 2016-2018 NSCH, children ages 10-17 who were exposed to ACEs had higher rates of overweight and obesity, the odds of which may be reduced when children also have higher family resilience.

Is the Black-White mental health paradox consistent across age, gender, and psychiatric disorders?

OBJECTIVES

The Black-White mental health epidemiological paradox (i.e. Black Americans' lower or similar rates of mental disorder relative to Whites) characterizes the literature on race and mental health. Yet, research has generally paid less attention to how such findings may vary across other social statuses that shape mental health. This study assessed whether the Black-White paradox is consistent across gender, age groups, and psychiatric disorders, including lifetime mood, anxiety, and substance use disorders.

METHOD

We used data from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL), 2001-2003 (N = 4,591 African Americans; 6,668 non-Hispanic Whites). Psychiatric disorders were measured with the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI). Binary logistic regression models were conducted to assess racial patterns of lifetime mental disorders across age and gender. Wald tests were performed to assess age and gender group differences in Black-White patterns of mental disorder.

RESULTS

The Black-White mental health paradox generally extends across lifetime mood, anxiety, and substance use disorders and is consistent across age and gender groups. One exception is middle-aged (45-64 years) Black men, who had higher odds of lifetime substance use disorder relative to their White male middle-aged peers. This difference is no longer statistically significant after accounting for education and employment. We also found more similarity in mental disorders between older Blacks and Whites relative to their younger counterparts, suggesting that Black-White mental health differences are most pronounced among younger age groups.

CONCLUSION

Our findings contribute to the broader literature on the Black-White mental health paradox by demonstrating that this epidemiological pattern persists across various mental disorder types and, at times, depends on age group and gender. Given that Black-Whte differences are less pronounced among older adults, future research should consider the ways life course theory might inform our understanding of the paradox. Findings also suggest that substance use services are critical to address the needs of middle-aged Black men of lower socioeconomic status who are disproportionately affected by substance use disorder, yet have relatively lower mental health care utilization rates.

Do Discrimination and Negative Interactions with Family Explain the Relationship between Interracial Relationship Status and Mental Disorder?

Using the stress process model, the authors investigate whether individuals in interracial relationships experience greater risk for past-year mood and anxiety disorder compared with their same-race relationship counterparts. The authors also assess interracial relationship status differences in external stressors (i.e., discrimination and negative interactions with family) and whether stress exposure explains mental disorder differences between individuals in interracial versus same-race romantic partnerships. Data are from the National Survey of American Life (2001–2003). Results show that individuals in interracial relationships are at greater risk for anxiety disorder (but not mood disorder) relative to those in same-race relationships. Interracially partnered individuals also report more discrimination from the public and greater negative interactions with family. External stressors partially explain the higher risk for anxiety disorder among individuals in interracial partnerships. This study addresses a void in the literature on discrimination, family relationships, and health for the growing population of individuals in interracial unions.

Documenting Behavioral Health Needs in an Urban Setting

Most local communities lack the capacity to conduct behavioral health needs assessments. The purpose of this paper is to describe a mixed-methods approach to estimate the behavioral health needs in St. Louis, MO. Data were drawn from multiple sources including local and state government prevalence estimates, medical records, and key informant interviews. The most prevalent behavioral conditions were depression, alcohol, and drug abuse. Priority populations were residents with co-occurring disorders, youth transitioning into the adult behavioral system, and homeless individuals with behavioral health needs. Treatment rates for behavioral health conditions were low, relative to identified needs. There are significant provider shortages and high staff turnover, which extend wait times, diminish the quality of care, and contribute to the use of emergency departments for behavioral health care. The data and methods described in this paper could be helpful to other municipalities that are looking to conduct behavioral health needs assessments.

Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence

The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.

Race and SES Differences in Psychosocial Resources: Implications for Social Stress Theory

Social stress theory predicts that psychosocial resources shape health inequalities but is less clear about the ways in which the availability of resources differs across racial and socioeconomic groups. Using data from the Nashville Stress and Health Study (N = 1,214), the present study assessed racial and socioeconomic status (SES) differences in mastery, self-esteem, and social support; evaluated the extent to which SES accounts for racial differences in resources; and considered the interactive roles of race and SES in shaping resources among Black and White adults. Results show Blacks have greater access to resources, but SES yields greater psychosocial benefits among Whites. Findings demonstrate that SES and race may jointly and independently shape access to resources. This study contributes to the broader literature on status distinctions in psychosocial resources, providing new insights into the ways in which race and SES shape access to these health-protective resources while also raising several questions for future research.

Psychiatric Disorders Among Older Black Americans: Within- and Between-Group Differences

Psychiatric disorders impose significant personal, social, and financial costs for individuals, families, and the nation. Despite a large amount of research and several journals focused on psychiatric conditions, there is a paucity of research on psychiatric disorders among Black Americans (i.e., African Americans and Black Caribbeans), particularly older Black Americans. The present literature review examines research on psychiatric disorders among older Black Americans and provides a broad overview of research findings that are based on nationally representative studies. Collectively, this research finds: (1) older African Americans have lower rates of psychiatric disorders than younger African Americans; (2) family support is not protective of psychiatric disorders, whereas negative interaction with family members is a risk factor; (3) everyday discrimination is a risk factor for psychiatric disorders; (4) both older African Americans and African American across the adult age range have lower prevalence rates of psychiatric disorders than non-Latino whites; (5) Black Caribbean men have particularly high rates of depression, posttraumatic stress disorder, and suicide attempts; and (6) a significant proportion of African American older adults with mental health disorders do not receive professional help. This literature review also discusses the “Race Paradox” in mental health, the Environmental Affordances Model, and the importance of investigating ethnicity differences among Black Americans. Future research directions address issues that are directly relevant to the Black American population and include the following: (1) understanding the impact of mass incarceration on the psychiatric disorders of prisoners’ family members, (2) assessing the impact of immigration from African countries for ethnic diversity within the Black American population, (3) examining the impact of racial identity and racial socialization as potential protective factors for psychiatric morbidities, and (4) assessing racial diversity in life-course events and their impact on mental health.

Pharmaceutical Side Effects and Mental Health Paradoxes among Racial-Ethnic Minorities

Sociologists have long struggled to explain the minority mental health paradox: that racial-ethnic minorities often report better mental health than non-Hispanic whites despite social environments that seem less conducive to well-being. Using data from the 2008-2013 Medical Expenditure Panel Survey (MEPS), this study provides a partial explanation for the paradox rooted in a very different disparity. Evidence from MEPS indicates that non-Hispanic whites consume more pharmaceuticals than racial-ethnic minorities for a wide variety of medical conditions. Moreover, non-Hispanic whites consume more pharmaceuticals that although effective in treating their focal indication, include depression or suicide as a side effect. In models that adjust for the use of such medications, the minority advantage in significant distress is reduced, in some instances to statistical nonsignificance. Although a significant black and Hispanic advantage in a continuous measure of distress remains, the magnitude of the difference is reduced considerably. The relationship between the use of medications with suicide as a side effect and significant distress is especially large, exceeding, for instance, the relationship between poverty and significant distress. For some minority groups, the less frequent use of such medications is driven by better health (as in the case of Asians), whereas for others, it reflects a treatment disparity (as in the case of blacks), although the consequences for the mental health paradox are the same. The implications of the results are discussed, especially with respect to the neglect of psychological side effects in the treatment of physical disease as well as the problem of multiple morbidities.

Race-Ethnicity, Social Roles, and Mental Health: A Research Update

Social role involvement engenders sense of purpose and meaning to life, which sustains positive mental health. Racism within American society, however, results in experiences that disadvantage ethnoracial minorities, thus making it likely that social roles do not have universal remunerations. Using the Collaborative Psychiatric Epidemiology Surveys (N = 12,526), this study explores the association between role participation and psychological distress across nine ethnoracial groups. Results indicate that engaging in many roles is associated with better mental health for all ethnoracial groups. However, the combination of social roles has distinct effects for certain groups. We discuss the implications of the study findings for medical sociology, in general, and the social roles literature, in particular.

Increased Cardiovascular Disease Risk in Veterans With Mental Illness

Background:

Although previous studies have demonstrated an association between various mental illnesses and cardio-cerebrovascular disease (CVD) risk, few have compared the strength of association between different mental illnesses and CVD risk.

Methods and Results:

We assessed the association of psychiatric diagnoses (psychosis, bipolar disorder, depression, anxiety, and posttraumatic stress disorder) with major CVD outcomes (CVD events and CVD mortality) over 5 years, using a national primary prevention cohort of military veterans receiving care in the Department of Veterans Affairs. Data were linked from the Department of Veterans Affairs, Centers for Medicare and Medicaid Services, and Centers for Disease Control and Prevention National Death Index databases. We used multiple logistic regression to examine how the presence of a psychiatric diagnosis at baseline (2005–2009) was associated with CVD outcomes over the next 5 years (January 1, 2010, to December 31, 2014) stratified by sex, adjusting for other psychiatric diagnoses, as well as age, race, conventional CVD risk factors as calculated by the Veterans Affairs Risk Score-CVD, and antipsychotic and anticonvulsant/mood stabilizer medication prescriptions. Approximately 1.52 million men and over 94 000 women met our inclusion criteria. In the fully adjusted model, among men, we found that depression, psychosis, and bipolar disorder were predictive of both CVD events and CVD mortality, with psychosis having the largest effect size (eg, adjusted odds ratio, 1.48; CI, 1.41–1.56; P <0.001 for psychosis and CVD mortality). Among women, only psychosis and bipolar disorder were predictive of both CVD events and CVD mortality, again with psychosis having the largest effect size (eg, adjusted odds ratio, 1.97; CI, 1.52–2.57; P <0.001 for psychosis and CVD mortality). Anxiety was associated with only CVD mortality in men, and depression was associated with only CVD events in women.

Conclusions:

Consistent with the hypothesis that chronic stress leads to greater CVD risk, multiple mental illnesses were associated with an increased risk of CVD outcomes, with more severe mental illnesses (eg, primary psychotic disorders) having the largest effect sizes even after controlling for other psychiatric diagnoses, conventional CVD risk factors, and psychotropic medication use.

The Black-White Paradox Revisited: Understanding the Role of Counterbalancing Mechanisms during Adolescence

The tendency for blacks to report similar or better mental health than whites has served as an enduring paradox in the mental health literature for the past three decades. However, a debate persists about the mechanisms that underlie this paradox. Drawing on the stress process framework, we consider the counterbalancing roles of self-esteem and traumatic stress exposure in understanding the "black-white paradox" among U.S. adolescents. Using nationally representative data, we observe that blacks have higher levels of self-esteem than whites but also encounter higher levels of traumatic stress exposure. Adjusting for self-esteem reveals a net higher rate of mood disorders and distress among blacks relative to whites, and differences in traumatic stress exposure mediate this association. In the full model, we show that self-esteem and stress exposure offset each other, resulting in a null association between race and mood disorders and a reduced association between race and distress.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

Exploring Causes of Depression and Anxiety Health Disparities (HD) by Examining Differences between 1:1 Matched Individuals

Poor comparability of social groups is one of the major methodological problems that threatens the validity of health disparities (HD) research findings. We illustrate a methodological solution that can additionally unpack the mechanisms behind differential effects on depression and anxiety. We describe racial/ethnic differences in the prevalence of depression and anxiety scores between Black and White women using classic methods, and then we illustrate a 1:1 matching procedure that allows for building of individual-level difference scores, i.e., actual HD difference score variables, for each pair of comparable participants. We compare the prevalence of depression disorder between Black and White young women after matching them 1:1 on common socio-economic characteristics (age, employment, education, and marital status). In essence, we follow matching or stratification methods, but make a step further and match cases 1:1 on propensity scores, i.e., we create Black–White ‘dyads’. Instead of concluding from plain comparisons that 11% more White young women (18–30 years old) report a depressive disorder than Black young women, the matched data confirms the trend, but provides more nuances. In 27% of the pairs of comparable pairs the White woman was depressed (and the comparable Black woman was not), while in 15% of the pairs the Black woman was depressed (and the comparable White woman was not). We find that Black-to-White disparities in neighborhood disorder do not predict depression differences (HDs), while such an effect is evident for anxiety HDs. The 1:1 matching approach allows us to examine more complex HD effects, like differential mediational or resilience mechanisms that appear to be protective of Black women’s mental health.

Championing the resilience of sub-Saharan adolescents: pointers for psychologists

In this article, I argue that an ecological systems approach to resilience – specifically, one that is sensitive to how contextual determinants shape successful adaptation differentially – offers a meaningful way to enable sub-Saharan adolescents to adapt well to the apparently intractable risks to their health and well-being. Accordingly, I draw on studies of child and adolescent resilience from sub-Saharan Africa and the global North to show that the resilience field has largely moved beyond individual-focused theories of resilience that have the (long-term) potential to jeopardize adolescent health and well-being and advance neoliberal agendas. I emphasize that the recent attention to differentially impactful resilience-enablers casts suspicion on incautious application of universally recurring resilience-enablers. Allied to this, I problematize the delay in the identification of resources that impact the resilience of sub-Saharan adolescents differentially. Finally, I distil implications for resilience-directed praxis and research that have the potential to advance the championship of adolescent resilience in sub-Saharan Africa.

Secular and Religious Social Support Better Protect Blacks than Whites against Depressive Symptoms

Purpose: Although the protective effect of social support against depression is well known, limited information exists on racial differences in this association. The current study examined Black-White differences in the effects of religious and secular emotional social support on depressive symptoms in a national sample of older adults in the United States. Methods: With a longitudinal prospective design, the Religion, Aging and Health Survey, 2001⁻2004, followed 1493 Black (n = 734) and White (n = 759) elderly individuals (age 66 and older) for three years. Race, demographics (age and gender), socio-economics (education and marital status) and frequency of church attendance were measured at baseline in 2001. Secular social support, religious social support, chronic medical conditions and depressive symptoms [8- item Center for Epidemiological Studies-Depression scale (CES-D)] were measured in 2004. Multiple linear regression models were used for data analysis.

RESULTS

In the pooled sample, secular and religious social support were both protective against depressive symptoms, net of all covariates. Race interacted with secular (β = −0.62 for interaction) and religious (β = −0.21 for interaction) social support on baseline depressive symptoms (p < 0.05 for both interactions), suggesting larger protections for Blacks compared to Whites. In race-specific models, the regression weight for the effect of secular social support on depressive symptoms was larger for Blacks (β = −0.64) than Whites (β = −0.16). Conclusion: We found Black—White differences in the protective effects of secular and religious social support against depressive symptoms. Blacks seem to benefit more from the same level of emotional social support, regardless of its source, compared to Whites.

Modeling racial disparities in physical health via close relationship functioning: A life course approach

OBJECTIVE

The aim of the present study was to test a life course model in which racial disparities in physical health between Caucasian and African Americans are driven by disparities in close relationship functioning. This model also examined relative evidence for intergenerational transmission of relationship functioning and ongoing exposure to prejudice and discrimination as two pathways that might shape adult relationship functioning.

METHOD

A sample of 523 Caucasian and African American men and women were prospectively tracked from a birth cohort initiated in the 1960s. Reports of parental relationship functioning were obtained from participants and their mothers in adolescence. In midlife, participants completed measures of perceived discrimination (lifetime and everyday discrimination), close relationship functioning (relationship strain and support) and physical health (self-rated health, resting heart rate and systolic blood pressure).

RESULTS

As hypothesized, close relationship functioning was a strong predictor of physical health in adulthood. Furthermore, we observed that perceived discrimination over the life course was linked to impaired relationship functioning. Evidence for intergenerational transmission of relationship functioning was more equivocal.

CONCLUSION

Racial disparities in physical health may be maintained via social factors throughout the life course. Although such factors have sometimes been considered outside the purview of the medical field, it is vital that researchers and clinicians begin to more fully address the implications of social forces in order to remediate racial health disparities.

The race paradox in subjective wellbeing among older Americans

This study aims to assess racial differences in subjective wellbeing (SWB) and to examine whether the pathways of social support and social engagement to SWB vary by racial groups in the United States of America. Using a local sample (N = 1,035) and a nationally representative sample of the Health and Retirement Study (N = 7,718), we compared life satisfaction and happiness between non-Hispanic Whites and Blacks aged 55 and over. We evaluated the extent to which race, other socio-demographic characteristics, health, social engagement and social support explained the variances in SWB and examined the moderation effects of race on the relationships of SWB with age, social support and social engagement. Multiple regression analyses showed that non-Hispanic Blacks were at least as satisfied as, and even happier than White peers, after equalising social resources and health variables. Social support was significantly related to SWB, and it seemed that positive support was more important to Whites than to Blacks in predicting life satisfaction. In addition, the racial crossover effect existed, that is, the old-old (80+) Blacks were happier than their White peers. Findings indicate a national trend of the race paradox in SWB and underscore the importance of social support in promoting older adults’ wellbeing. Future research is recommended to investigate other potential mechanisms among Black older Americans to explain their relatively better SWB.

Positive and Negative Affect More Concurrent among Blacks than Whites

Background: While positive and negative affect are inversely linked, people may experience and report both positive and negative emotions simultaneously. However, it is unknown if race alters the magnitude of the association between positive and negative affect. The current study compared Black and White Americans for the association between positive and negative affect. Methods: We used data from MIDUS (Midlife in the United States), a national study of Americans with an age range of 25 to 75. A total number of 7108 individuals were followed for 10 years from 1995 to 2004. Positive and negative affect was measured at baseline (1995) and follow-up (2004). Demographic (age and gender), socioeconomic (education and income) as well as health (self-rated health, chronic medical conditions, and body mass index) factors measured at baseline were covariates. A series of linear regressions were used to test the moderating effect of race on the reciprocal association between positive and negative affect at baseline and over time, net of covariates. Results: In the pooled sample, positive and negative affect showed inverse correlation at baseline and over time, net of covariates. Blacks and Whites differed in the magnitude of the association between positive and negative affect, with weaker inverse associations among Blacks compared to Whites, beyond all covariates. Conclusion: Weaker reciprocal association between positive and negative affect in Blacks compared to Whites has implications for cross-racial measurement of affect and mood, including depression. Depression screening programs should be aware that race alters the concordance between positive and negative affect domains and that Blacks endorse higher levels of positive affect compared to Whites in the presence of high negative affect.

The Link between Mastery and Depression among Black Adolescents; Ethnic and Gender Differences

PURPOSE

Although the link between depression and lower levels of mastery is well established, limited information exists on ethnic and gender differences in the association between the two. The current study investigated ethnic, gender, and ethnic by gender differences in the link between major depressive disorder (MDD) and low mastery in the United States.

METHODS

We used data from the National Survey of American Life-Adolescent supplement (NSAL-A), 2003-2004. In total, 1170 Black adolescents entered the study. This number was composed of 810 African-American and 360 Caribbean Black youth (age 13 to 17). Demographic factors, socioeconomic status (family income), mastery (sense of control over life), and MDD (Composite International Diagnostic Interview, CIDI) were measured. Logistic regressions were used to test the association between mastery and MDD in the pooled sample, as well as based on ethnicity and gender.

RESULTS

In the pooled sample, a higher sense of mastery was associated with a lower risk of MDD. This association, however, was significant for African Americans but not Caribbean Blacks. Similarly, among African American males and females, higher mastery was associated with lower risk of MDD. Such association could not be found for Caribbean Black males or females.

CONCLUSION

Findings indicate ethnic rather than gender differences in the association between depression and mastery among Black youth. Further research is needed to understand how cultural values and life experiences may alter the link between depression and mastery among ethnically diverse Black youth.

Reciprocal Associations between Depressive Symptoms and Mastery among Older Adults; Black-White Differences

Purpose: Although higher levels of depressive symptoms and lower levels of sense of mastery tend to be comorbid, limited information exists on racial differences in the longitudinal associations between the two over time. The current study compared Black and White American older adults for the longitudinal links between depressive symptoms and mastery in the United States. Methods: Using data from the Religion, Aging, and Health Survey, 2001-2004, this longitudinal cohort study followed 1493 Black (n = 734) and White (n = 759) elderly individuals (age 66 or more) for 3 years. Depressive symptoms [Center for Epidemiological Studies-Depression scale (CES-D), 8 items] and mastery (Pearlin Mastery Scale, 7 items) were measured in 2001 and 2004. Demographics, socio-economics, and physical health were covariates and race was the focal moderator. Multi-group structural equation modeling was used for data analysis, where groups were defined based on race. Results: Among White but not Black older adults, higher levels of depressive symptoms at baseline predicted a greater decline in sense of mastery over 3 years of follow-up. Similarly among Whites but not Blacks, individuals with lower mastery at baseline developed more depressive symptoms over time. Conclusion: Findings are indicative of Black-White differences in reciprocal associations between depressive symptoms and mastery over time. Race alters how depression is linked to changes in evaluation of self (e.g., mastery) over time.

Ethnic and Nativity Differences in the Social Support-Physical Health Association Among Black Americans

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized.

Serious Psychological Distress Among African Americans: Findings from the National Survey of American Life

Despite their low social standing, there remains a paucity of research on psychological distress among African Americans. We use data from the 2001-2003 National Survey of American Life to explore a wide array of social and economic predictors of psychological distress among African American adults ages 18 and older, including previous incarceration, history of welfare receipt, and having a family member who is either currently incarcerated or homeless. Younger age, lower income, lower educational attainment, and lower self-rated health and childhood health are associated with higher levels of psychological distress among African Americans. We also find a strong association between higher levels of material hardship, previous incarceration history, and the presence of a family member who is either incarcerated or homeless and higher levels of psychological distress. The findings highlight the importance of considering unique types of social disadvantage experienced by African Americans living in a highly stratified society.

Stressful Life Events and Risk of Depression 25 Years Later: Race and Gender Differences

BACKGROUND

Although stressful life events (SLEs) predict subsequent risk of developing a major depressive episode (MDE), limited information exists on whether or not race and gender alters the predictive role of SLE on risk of MDE over a long-term period. The current study explored race and gender differences in the long-term predictive role of SLE at baseline (1986) on subsequent risk of MDE 25 years later (2011) in a nationally representative cohort in the United States.

METHODS

Using a life course epidemiological approach, this longitudinal study borrowed data from the Americans' Changing Lives (ACL) Study 1986-2011. Main predictor of interest was baseline SLE over the last 3 years measured at 1986. Main outcome was risk of MDE [Composite International Diagnostic Interview (CIDI)] 25 years later (2011). Covariates included demographics, socioeconomics, depressive symptoms [Center for Epidemiological Studies-Depression Scale (CES-D)], chronic medical conditions, and health behaviors measured at baseline (1986). Gender and race were the focal moderators. We employed logistic regressions in the pooled sample, and specific to race and gender, to test whether or not SLE × race and SLE × gender interactions are significant.

RESULTS

In the pooled sample, baseline SLE (1986) predicted risk of MDE 25 years later (2011). We also found a gender by SLE interaction, suggesting a stronger predictive role of SLE for subsequent clinical depression for men compared to women. Race did not modify the predictive role of SLE on subsequent risk of MDE 25 years later.

CONCLUSION

How SLE predicts MDE 25 years later differs for men and women, with a stronger predictive role for men compared to women. More research is needed to better understand the complex links between gender, sex, stress, and depression.

Association Between Stressful Life Events and Depression; Intersection of Race and Gender

BACKGROUND

Although stressful life events (SLEs) and depression are associated, we do not know if the intersection of race and gender modifies the magnitude of this link. Using a nationally representative sample of adults in the USA, we tested if the association between SLE and major depressive episode (MDE) depends on the intersection of race and gender.

METHODS

Data came from the National Survey of American Life (NSAL), 2003, a cross-sectional survey that enrolled 5899 adults including 5008 Blacks (African-Americans or Caribbean Blacks), and 891 Non-Hispanic Whites. Logistic regression was used for data analysis. Stressful life events (past 30 days) was the independent variable, 12-month MDE was the dependent variable, and age, educational level, marital status, employment, and region of country were controls.

RESULTS

In the pooled sample, SLE was associated with MDE above and beyond all covariates, without the SLE × race interaction term being significant. Among men, the SLE × race interaction was significant, suggesting a stronger association between SLE and MDE among White men compared to Black men. Such interaction between SLE × race could not be found among women.

CONCLUSIONS

The association between SLE and depression may be stronger for White men than Black men; however, this link does not differ between White and Black women. More research is needed to better understand the mechanism behind race by gender variation in the stress-depression link.